Everything you need to know about perimenopause: a comprehensive guide to understanding, experiencing, and supporting this stage of life

La périménopause est une période charnière dans la vie d’une femme. Ainoha™ propose de la définir comme l’ensemble de la transition hormonale féminine : elle débute avec les premières variations hormonales (préménopause) et se poursuit jusqu’à la stabilisation hormonale après la ménopause, appelée post-ménopause.

This hormonal transition phase, which is often misunderstood, is nevertheless essential to understand. In this article, we discuss its definition, symptoms, duration, health impacts, medical treatment options, as well as practical advice and some common misconceptions.

What is perimenopause?

La périménopause signifie littéralement « autour de la ménopause ». Elle correspond à la période de transition hormonale qui entoure cet événement. Pourtant, dans le langage courant, elle est souvent confondue avec la préménopause, qui ne représente en réalité que la phase de début des premières variations hormonales.

Afin de mieux clarifier cette étape clé de la vie hormonale féminine, Ainoha™ a choisi de redéfinir la périménopause (différence entre la périménopause et la préménopause) comme l’ensemble de la période de transition hormonale chez la femme : depuis les premières fluctuations hormonales (période de préménopause) jusqu’à la période de stabilisation après la ménopause, appelée post-ménopause.

Perimenopause is an important stage because it marks a real transition in a woman's hormonal life. It corresponds to the period surrounding menopause, with a "before" and an "after." Before, the body functions with hormonal cycles that are still active, even if they become more irregular. After menopause, a new hormonal balance is established, with permanently lower levels of estrogen and progesterone. This perspective provides a better understanding of the changes that can occur during this phase and allows for more appropriate support for women, well before menopause.

Check out our blog post on this topic: What is perimenopause?

At what age can premenopause begin, and how long does it last?

La préménopause, est donc la période de transition avant l’arrêt définitif des cycles, c’est à dire l’arrêt de l’ovulation, se traduisant donc par l’arrêt des menstruations. Cette phase de préménopause commence lorsque les ovaires réduisent progressivement leur production d’hormones sexuelles, notamment les œstrogènes et la progestérone, entraînant une série de changements physiologiques. Contrairement à la ménopause dont la définition médicale est l’absence de règles depuis 12 mois consécutifs, la période de préménopause est marquée par des fluctuations hormonales et parfois des irrégularités des cycles. Cette phase de préménopause peut débuter dès 35 ans chez certaines femmes. Cela ne signifie toutefois pas que la fertilité est immédiatement compromise ni que la ménopause est imminente : cette période de préménopause peut durer de nombreuses années avant l’arrêt définitif des cycles.

Discover our blog articles on this topic: What is the average age of premenopause? and How long does perimenopause last?

Why does premenopause occur?

Premenopause is a physiological transition phase leading up to menopause. It begins when the ovaries start to function less regularly due to a gradual decline in the number and quality of ovarian follicles. This change disrupts ovulation and leads to more irregular menstrual cycles, which may be longer or shorter, or occasionally even without ovulation, resulting in a lack of periods.

Sur le plan hormonal, cette période est surtout marquée par des fluctuations importantes des hormones sexuelles. La progestérone a tendance à diminuer en premier. En effet, la qualité du corps jaune (la structure qui se forme après l’ovulation) diminue avec l’âge et l’avancée dans la préménopause, ce qui réduit la production de progestérone.

Dans le même temps, les œstrogènes peuvent rester relativement stables, voire parfois augmenter. Le cerveau tente en effet de stimuler les ovaires en sécrétant davantage de FSH pour recruter des follicules, ce qui peut temporairement maintenir la production d’œstrogènes. Au fil des années, les follicules deviennent cependant moins sensibles aux signaux hormonaux envoyés par le cerveau (hypophyse). Les ovulations deviennent plus rares, les cycles s’espacent, et les œstrogènes finissent à leur tour par diminuer progressivement, jusqu’à l’arrêt définitif des règles qui marque la ménopause.

These hormonal fluctuations characteristic of premenopause can influence many bodily functions and manifest themselves in changes in energy levels, sleep patterns, mood, libido, or intimate comfort, with intensity varying greatly from woman to woman.

The most common symptoms of perimenopause

The symptoms of premenopause vary greatly from one woman to another, both in nature and intensity. They are mainly related to the hormonal fluctuations that characterize this transition period.

At first, symptoms often reflect a relative decrease in progesterone. This can result in more severe premenstrual syndrome (PMS), shorter cycles, sometimes heavier periods, or even premenstrual spotting. Menstrual cycles also become more irregular, alternating between longer and shorter periods.

Over time, asestrogen productionbegins to decline, other signs may appear. Among the most common are hot flashes, night sweats, sleep disturbances, and persistent fatigue. Changes in the skin and mucous membranes may also occur, such as dry skin or vaginal dryness, sometimes associated with a decrease in libido.

This hormonal transition can also affect emotional and cognitive balance: irritability, mood swings, anxiety, difficulty concentrating, or feelings of "brain fog" may occur. Some women also report joint or muscle pain, gradual weight gain, or palpitations.

However, the intensity and combination of these symptoms vary greatly from woman to woman, with some experiencing few symptoms during this period, while others feel the effects of these hormonal fluctuations more acutely.

How is perimenopause diagnosed?

The onset of premenopause cannot be detected "directly" by a blood test. Conversely, menopause is more easily identifiable biologically, with low estrogen and progesterone levels associated with elevated FSH and LH levels.

It is therefore essential to learn to observe and understand the signals sent by the body, which reflect the initial hormonal changes during this premenopausal phase.

The first changes may be subtle: changes in menstrual cycles, the onset or worsening of premenstrual syndrome (PMS), less restful sleep, fluctuations in energy or mood, unusual fatigue, decreased libido, or increased emotional sensitivity.

Premenopause is above all a natural biological transition that encourages self-awareness, mindful observation, and support, in order to better navigate this period of change. Discover our blog article on this topic: How do you know if you are going through premenopause?

Can you experience hot flashes during perimenopause?

Contrary to popular belief, hot flashes are not exclusive to menopause. They can occur as early as premenopause.

During this period, hormone levels do not yet drop permanently, but they fluctuate significantly, particularly estrogen. These hormonal variations can disrupt the temperature regulation center located in the hypothalamus, which can cause sudden hot flashes, sometimes accompanied by redness or sweating.

Therefore, the presence of hot flashes does not necessarily mean that a woman has already reached menopause. They may simply reflect the initial hormonal fluctuations of perimenopause, a transitional phase that can last several years before menstruation finally stops.

If you suffer from hot flashes or other uncomfortable symptoms, don't hesitate to consult a healthcare professional, who can guide you toward the solutions best suited to your situation.

Management of perimenopause

The management of perimenopause is based on a personalized approach, taking into account the severity of symptoms, overall health, and the preferences of each woman. When symptoms become bothersome, medical treatment may be considered in consultation with a healthcare professional.

Hormone replacement therapy (HRT) may be recommended in certain cases before menopause. Contrary to popular belief, hormone replacement therapy (HRT) is not only for menopause: in some cases, it may also be recommended during premenopause, when symptoms related to hormonal fluctuations become bothersome and affect quality of life. Depending on each woman's situation, healthcare professionals may recommend progesterone alone or a combination of progesterone and estrogen, tailoring treatment to each individual case.

HRT can help reduce hot flashes, improve sleep quality and mood, and play a role in preventing bone loss.

Non-hormonal approaches can also be considered to support this transition period and alleviate certain symptoms. The use of specific dietary supplements can provide valuable support.

During premenopause, particularly in cases of premenstrual syndrome (PMS), chaste tree, evening primrose oil, and borage oil are traditionally used to support female hormonal balance. Chaste tree mainly acts on cycle regulation and the balance between estrogen and progesterone. Evening primrose and borage oils, rich in essential fatty acids, contribute to female comfort and can help alleviate certain symptoms related to hormonal fluctuations.

À la ménopause, d’autres approches peuvent être proposées, pour aider à réduire les bouffées de chaleur et certains autres symptômes liés à la baisse des œstrogènes. On peut citer le trèfle rouge, les isoflavones de soja (notamment l’équol) ou encore l’actée à grappes noires, souvent utilisées en complémentation. Le trèfle rouge et l’équol agissent principalement grâce à leur activité phyto-œstrogénique, c’est-à-dire leur capacité à se lier aux récepteurs des œstrogènes et à mimer partiellement leurs effets dans l’organisme. Ce mode d’action explique leur utilisation pour aider à atténuer certains symptômes de la ménopause, notamment les bouffées de chaleur et certains inconforts liés à la baisse hormonale.

Local treatments, such as lubricants or vaginal care products, can help relieve intimate dryness that may occur.

Regardless of the treatment option chosen, it is essential to discuss it with a healthcare professional.

Furthermore, it is important to remember that as long as menstruation continues, pregnancy is still possible during premenopause. Premenopause does not mean the end of fertility, unlike menopause. It is therefore essential to continue using appropriate contraception during premenopause if pregnancy is not desired.

Practical tips for coping better with perimenopause

Even without medical treatment, adjusting your lifestyle can help reduce the symptoms of perimenopause and promote overall well-being. A balanced diet rich in calcium, vitamins, and essential nutrients plays a key role in maintaining bone health and metabolism. Regular physical activity not only helps preserve bone and muscle mass, but also supports mood, stress management, and sleep quality.

Paying special attention to sleep and stress management is also essential, as hormonal fluctuations can disrupt biological rhythms. Reducing alcohol consumption and quitting smoking can also help limit certain symptoms, such as hot flashes, and preserve cardiovascular health.

Emotionally, psychological support can be beneficial when mood swings, anxiety, or emotional sensitivity become more pronounced. Behavioral therapies or psychological counseling offer a listening ear and concrete tools to help you get through this transition period.

Check out our blog post on this topic: Natural solutions for a successful transition to perimenopause.

Frequently Asked Questions (FAQ)

Is perimenopause a disease?

No: it is a natural phase of reproductive life, marked by gradual hormonal changes. These changes begin during the premenopausal period and eventually stabilize after menopause (in postmenopause) with a drastic and lasting drop in female hormones.

Can you get pregnant during perimenopause?

Yes: during premenopause, women remain fertile even though ovulation may be of lower quality and hormone levels may not be optimal. As long as menstruation has not stopped for 12 months (the medical definition of menopause), fertility is still possible and appropriate contraception is recommended if pregnancy is not desired. Find out more in our detailed answer here: Can you get pregnant during premenopause?

Are all symptoms of perimenopause permanent?

No: Not all symptoms associated with perimenopause are permanent. They are mainly linked to hormonal fluctuations during premenopause and the sharp drop in hormone levels at menopause.

During premenopause, hormonal fluctuations can lead to irregular cycles, more severe premenstrual syndrome, or even more painful periods, symptoms that will naturally end with the permanent cessation of periods at menopause.

During menopause, the drop in estrogen levels can cause hot flashes, night sweats, and vaginal dryness. Hot flashes are common and last an average of 5 to 7 years, although they can sometimes persist longer. Vaginal dryness, on the other hand, can persist over time because it is linked to sustained low estrogen levels after menopause.

However, the duration and intensity of symptoms vary greatly from one woman to another and generally tend to diminish over time.

More detailed frequently asked questions can be found in our dedicated blog post: Frequently asked questions about perimenopause.